Must dysphagic patients always receive food and water?

Abstract

For the great majority of severely dysphagic patients the health-care team will strive in earnest to provide necessary nutritional support, not only because of the direct suffering that results from inadequate caloric intake, but because nutritional deficiencies hamper the patient's ability to recover from other diseases. This may entail the services of the rehabilitation medicine department, the nutrition department, and the use of both medical and surgical services in the placement of nasogastric tubes, percutaneous endoscopic gastrostomy tubes, or surgically placed feeding gastrostomies or jejunostomies. Are there ever situations in which it is permissible to withhold or withdraw food and water? One June 1, 1987 the New York State Appellate Division rendered an opinion in the case entitled " In the Matter of Del io" [1]. The court reversed a lower court's order and ordered the feeding tube removed from a 33-year-old comatose man. There was evidence that the patient had expressed wishes not to be artificially maintained. The Appellate Division held that in this context there was no distinction between respiratory and nutritional support so that the patient's previously expressed wishes could be followed. The perceived connection between the medical care of the patient as it relates to the provision of nutrition and hydration (as discussed in this and prior court decisions) might cause us to rethink the medical decision making process. The provision of food and water to the severely dysphagic patient does not appear to be distinguishable in any morally relevant way from the provision of other life-sustaining medical treatments that may from time to time be withheld or withdrawn. There is occasionally concern that a patient is better off not undergoing or continuing